We plan to optimize a low cost, simple-to use, non-invasive imaging device, the Laser Scanning Digital Camera (LSDC). The LSDC has laser scanning illumination to increase contrast over a fundus camera and will have the user interface of a consumer-level digital camera. The LSDC serves as a screening device that provides image storage and a database for store and forward use by eye care providers. It is non-mydriatic and comfortable for patients. We will use the longest wavelength that provides acceptable contrast between 532 and 850 nm, thereby minimizing problems due to dark fundi and cataract. Our goal is for the LSDC to have an up front, one-time cost < 10% of high end imaging devices, but sensitivity of identifying patients at risk is the main criterion. We will investigate the key features for early detection with grading, plus the more advanced ones likely in the rural and urban underserved. Along with microaneurysms and hemhorrages, we will investigate macular edema including cystoid macular edema; retinal vascular changes and neovascularization; hard exudates; visualization through diabetic cataract; macular traction; retinal detachment; and iris neovascularization. We plan 5 Specific Aims: 1) build a prototype LSDC that images 40 deg of retina, 2) perform laboratory tests with a high end laser scanning device to determine if a comfortable, near IR light source can produce acceptable image quality instead of the typical uncomformably bright shorter wavelegnths that constrict the pupil, 3) explore what sensitvities and contrasts are achieved in pathological features using near IR imaging techniques, 4) optimize the optical design and wavelength selection of the LSDC, and 5) perform a blind grading study with prototype LSDC in the laboratory. Our goal is to reduce health disparities and the resulting loss of vision due to diabetic retinopathy. We are developing a method of screening for diabetic retinopathy that is far more comfortable than present nonmydriatic cameras that use bright light. The aim is to make an instrument that works like a consumer digital camera. Both of these factors may help reach more patients. We will investigate the key features considered necessary for early detection grading, and also more the serious damage that is typically discovered late in the rural and urban underserved.